Is a National War on Prescription Opiates Justified?

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By R Carter

Numbers get thrown around a lot when discussing the topic of opiate overdose deaths, making it difficult to compare or put into perspective, what the real impact is. For both those opposing and advocating for the use of opiates, most would agree that over prescribing on some level, has been a contributing factor over the years, but to what extent remains unknown. So the question remains, is the current policy of attacking doctors and prescribing really going to make a difference? For many it seems like an experiment with little justification and those who would deny it has unforeseen consequences, well they would be disingenuous.

Comparing OD deaths from opiates to groups like auto accidents is also misleading; such efforts are nothing more than scare tactics making the efforts of those who use them, contrived. The American public is well educated and informed, so providing real numbers for intelligent comparisons make more sense. There are two perspectives, leading causes of death published by the World Health Organization and Leading Causes of Death published by US National Vital Statistics.

Below are the leading causes of death according to the World Health Organization in 2016, using the International Statistical Classification of Diseases and Related Health Problems (ICD-10).  In this more honest view of the leading causes of death, deaths from drug disorders ranks 26th on the list with auto accidents ranking 9th.

 

The leading causes of death in the US follow a similar pattern, with data in the following chart taken from tables provided by the CDC for 2016.

Accidental deaths, which include auto accidents, poisonings and others, ranked 4th with 146,571 deaths reported in 2016. Of those, 63,632 were reported by the CDC as deaths related to opiates. Since the CDC does not cross reference overdose deaths related to opiates with data from Prescription Drug Monitoring Programs (PDMP), I will use percentages collected by Ohio which does. When excluding opiate overdose deaths from prescription opiates cross referenced through a PDMP database, roughly 95% of all opiate deaths were related to heroin and illicit Fentanyl in 2016. Applying these ratios to US data from the CDC, we then would expect to see about 50,905 deaths across the US related to illegal drug use leaving 12,726 related to prescription opiates. Following the same trends seen in Ohio, of the 12,726 related to prescription opiates, more than 85% involve more than one drug and those drugs 95% of the time were heroin, illicit Fentanyl, cocaine and other Class I narcotics.

What remains and is unaccounted for, are those chronic pain patients taking opiates as prescribed, compliant in their use, yet this group has no representation in our national debate on the subject of limiting opiates for medical purposes.

According to the CDC the addiction rate for people using opiates from all sources is only 0.78% per 100,000 population, while the addiction rate for alcohol is 6.6% per 100,000 people. It interesting to note that the genetic prevalence for addiction to both of these substances is roughly 5% per 100,000. So despite the ease by which alcohol can be obtained, the addiction rate parallels that seen in our genetic makeup. I’m not advocating for opiates being more readily available, but simply that the fear mongering and exaggeration we see going on by government agencies is unjustified in the face of facts we already have. Their failure to educate the public completely on these facts is likely motivated by bias, politics and other types of gains. 

These numbers and their ratios paint a convincing picture that most overdose deaths are related to illicit drug use, which is a law enforcement issues not a medical one. Therefore those who use opiates for chronic pain and are compliant in their use are in fact a very small percentage of the population, yet in this country’s current policy, chronic pain patients have been lumped together with illicit drug users.

This lack of detail, which has been available to the CDC and other Federal agencies since 2016, is conveniently left out when reporting to the public. But I want you to keep these details in mind, as I reason through using a similar approach for data collected on Diabetes.

Diabetes which ranks as 7th in the US had 79,535 deaths as reported by the CDC compared to 63,632 deaths related to opiates. Estimate are, 30.3 million Americans, or 9.4% of the population, had diabetes in 2016. It’s also estimated that 50 million Americans suffer from chronic pain with approximately 20% or 10 million of those suffering from a high impact chronic pain requiring treatment with pain medications or a combination of other treatments.

With a national response of limiting medication for chronic pain based on the death rate related to chronic pain, a rational question to ask would be, would America stand for a similar approach in a response to deaths related to Diabetes?

With just as many deaths occurring from diabetes shouldn’t we have a national policy of denying insulin and other diabetic drugs to diabetics? We know that there are diabetics who don’t follow the prescribed regime of treatment, so they are in fact contributing to the death toll related to diabetes.

If you extended this rationale based on number of deaths to other groups, wouldn’t such a rationale be justified for heart disease knowing that diet, smoking and alcohol contribute to heart disease and the number of people who die from it are 600% to 800% greater than those dying from opiates?

America’s policy since 2012 on deterring opiates has been one of blatant irrationality when viewed through the lens of how America responds to deaths caused by other diseases and conditions; and the only justification for treating medically compliant individuals in this manner is because of a minority which chooses to live outside the law, obtaining such substances by any means available to them.  

So is it right to limit medical care and access to everyone, because of the actions of a minority group? This is the question American’s have turned away from, too afraid or too indifferent to respond to.

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